The Price of Perfection: Individualism and Society in the Era of Biomedical Enhancement

1. The Technological Horizon

u Chapter 1 The Technological Horizon We can control biomedical enhancement only if we know to what the concept refers. Too broad a definition would sweep up and possibly discourage medical innovation. Too narrow a definition and pernicious enhancements might slip through the net. According to the dictionary, to enhance is to raise or lift up. A biomedical enhancement, then, is something biomedical that raises a person up by improving performance, appearance, or capability. If only it were that simple. In the first place, what is an improvement? It may be an objectively measured increase, for example, running faster or farther. But what about a more subjective improvement, such as a change in appearance ? Suppose a person changes her eye color to an odd variant, say, orange. Is this an improvement? What if other people find it ugly? For the most part, an enhancement is an improvement if the enhanced person thinks it is one. But one of the fundamental questions that will be taken up later in this book is what happens if other people disagree. Do they have the right to interfere? For the sake of argument, consider a change that most people are likely to regard as an improvement—the ability to read faster without any decrease in comprehension or enjoyment. Oxford professor Julian Savulescu defines enhancement as a “change in biology or psychology The Technological Horizon 7 of a person which increases the chances of leading a good life.”1 So presumably he would regard this type of improvement in reading ability as an enhancement. But what if, before the enhancement, the individual had read at a snail’s pace and now manages to keep up with other people ? The improvement then would not be so much an enhancement as a remedial step, or, if the person had previously read slowly because of a disorder like dyslexia, a treatment. Remediation and treatment raise interesting issues about how they should be controlled but quite different issues from those raised by enhancements. Some commentators restrict the notion of enhancement to changes that go beyond what is normal, so that a person whose performance or capabilities stayed within the normal range would not be regarded as enhanced. It is true that a person with below-normal reading ability would be deemed to be enhanced only if they then read faster than normal or at least read significantly better than average. But a person who started out with a reading ability within the range of normality also should be considered enhanced if they can now read faster, even if they remain within a normal range. Above-normal enhancements raise particularly troubling issues discussed later in the book, but it is a mistake to limit the term in this fashion. But what is “normal”? In some cases, it refers to the frequency with which a trait or capability occurs within a population. A person of normal height, for example, is arbitrarily defined as someone whose height lies within approximately two standard deviations of the population mean. Because approximately 95 percent of a population lies within two standard deviations of the mean (assuming a so-called normal or bell-shaped distribution), about one out of every 20 persons automatically is either abnormally tall or short. In other circumstances, what is considered normal may have no relationship to the distribution of a trait. Instead, the emphasis is on a degree of function that is considered to be a useful baseline, if not an ideal. Normal eyesight is deemed to be 20/20, but only about 35 percent of adults have 20/20 vision without some form of correction.2 (The 20/20 standard of normality stems from an eye chart created by a nineteenth-century physician; a person with 20/20 vision could read a character on the chart approximately threeeighths of an inch high from 20 feet away.) What is normal also may vary from place to place and time to time. The average American is taller than the average Japanese, and the average American is taller now than at the beginning of the century. Stan- 8 the price of perfection dards of normality, moreover, might change as the use of enhancements expands; if there were a drug that increased height, for example, the more people who used it, the taller the average height of the population would become. Despite its fluidity, however, the standard of normalcy is critical in...